IDIOPATHIC THROMBOCYTOPENIC PURPURA AND HELICOBACTER PYLORI INFECTION

Abstract

Introduction: It has recently been reported that a relationship between Idiopathic Thrombocytopenic Purpura (ITP) and Helicobacter Pylori (HP) infection exists in adult series. A link between the eradication of the infection itself and the remission of thrombocytopenia has also been observed. The aim of our study was to assess the prevalence of HP infection in children affected by chronic ITP and to verify the influence of the treatment on platelets counts. Patients and Methods: Our study lasted a minimum of 12 months and involved 31 children (Mean age: 136 months; range: 53-216 months; M/F: 10/20), all affected by chronic ITP. Patients were followed for 12 months: 6 months to assess chronic behaviour of ITP and 6 months for the follow-up. Unsplenectomized patients affected by chronic ITP underwent: Urea Breath Test (UBT), a search for HP antigen in stool samples as well as a search for HP antibodies in serum. In order for a diagnosis of HP infection to be made, two of the 3 results in the above mentioned tests had to be positive. Patients affected by HP infection were randomized into two groups: one group was treated with amoxicilline, claritromicine and omeprazole; the second group did not receive any therapy: Six weeks after the end of treatment patients underwent a UBT to assess their recovery from HP infection. In both groups, treated and untreated, for the 6 months following the diagnosis of chronic ITP, platelet counts were performed weekly (for Platelets <20000/mmcu), every 2-3 weeks (for Platelets between 20000 and 50000/mmcu) and monthly (for Platelets >50000/mmcu). Results: In our study the prevalence of HP infection in patients affected by chronic ITP was 22.5% (7/31 patients). Three of 7 patients were treated (Mean age: 174 months), and the mean platelet count at the onset of ITP was 72000/ mmcu (range 33000-128000/mmcu); 1/3 patients who received treatment did not recover from HP infection. In the 4 untreated patients (Mean age: 143 months) the mean platelet count was 94000/mmcu (range: 63000-124000/mmcu). At the follow-up the platelet count difference between treated and untreated patients and between infected and uninfected patients was not statistically significant. Conclusions: Our preliminary data do not suggest any relationship between ITP and HP infection.